Substance‐abusing Pregnant Women: Prenatal Intervention Using Ultrasound Consultation and Mentalization to Enhance the Mother–child Relationship and Reduce Substance Use

Abstract

Substance-abusing pregnant and parenting women are considered one of the most challenging, but important, target groups for developing early parenting interventions. Some valuable efforts to develop such interventions have been made in the organizational sector in Finland. However, there is a great need for new ways of work that would simultaneously concentrate in substance-abuse treatment and enhance parenting in public healthcare settings. The present article describes the background, content, and protocol of a new prenatal intervention developed for substance-abusing pregnant women in a hospital setting in public healthcare. The intervention includes two new elements and pathways aimed to enhance the mothers' curiosity toward her developing child and provide motivation to stay abstinent from substance use. The pathways are interactive ultrasound consultation and a new pregnancy diary, both using a parental mentalization focus. The intervention elements, experiences from running the intervention, evaluation protocol, and general characteristics of the study sample gained (n = 90) are described and discussed. Two case vignettes from the study sample are presented, and the applicability of this prenatal work with other groups and settings is considered.

A Novel 4D Ultrasound Parenting Intervention for Substance Using Pregnant Women in Finland: Participation in Obstetric Care, Fetal Drug Exposure, and Perinatal Outcomes in a Randomized Controlled Trial

“…In the control group, the participants who dropped out discontinued immediately after randomization, when they were allocated to the group not receiving the intervention. The intervention group was offered 4D ultrasounds and specific attention and theoretically grounded support for their prenatal parenting (Pajulo et al 2016). In the current study, the high attendance at the ultrasound sessions has been emphasized.…”

“…Both elements were designed to enhance prenatal parental mentalization and maternal-fetal attachment. The intervention method has been described earlier (Pajulo et al 2016). The control group received comprehensive treatment-as-usual in tertiary obstetric care.…”

“…Socio-demographic data was obtained at baseline with a questionnaire. Standardized self-report measures for the assessment of maternal mental health and prenatal parenthood were administered before the intervention (< 24th gwks) and after the intervention (> 34th gwks) (Pajulo et al 2016). After birth, the meconium was analyzed qualitatively with liquid chromatography-tandem mass spectrometry (LC-MS/MS) for tramadol, morphine, 6-monoasethylmorphine, codeine, oxycodone, methadone, buprenorphine, norbuprenorphine, amphetamine, methamphetamine, 3,4-methylenedioxymethamphetamine, 3,4-methylenedioxyamphetamine and a metabolite of tetrahydrocannabinol (THC-COOH).…”

A New Parental Mentalization Focused Ultrasound Intervention for Substance Using Pregnant Women. Effect on Self-reported Prenatal Mental Health, Attachment and Mentalization in a Randomized and Controlled Trial

“…Description of the Intervention Based on the theoretical rationale described in the introduction, two main intervention elements were chosen to enhance prenatal parental mentalization and maternal-fetal attachment in this study: interactive 4D ultrasound imaging and a new mentalization-focused pregnancy diary designed for this study ( Table 1). The method has been previously described in detail in a separate article (Pajulo et al 2016).…”

“…There is an urgent need for early interventions that would concurrently contribute to health practices, mental health and parenting of pregnant women with substance use disorders. A new mentalization-based parenting intervention utilizing interactive fourdimensional (4D) ultrasound imaging and a new pregnancy diary was designed for the prenatal care of women with a recent or current substance use problem (Pajulo et al 2016). The aim of the current study was to explore the efficacy of the intervention on prenatal parenting, i.e., maternalfetal attachment and parental mentalization, and maternal mental health in a randomized controlled trial (RCT).…”